Provider Demographics
NPI:1164708442
Name:STEPHENS, MARIA NICOLE (MARIA STEPHENS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:NICOLE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MARIA STEPHENS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 PLANTERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1619
Mailing Address - Country:US
Mailing Address - Phone:704-845-0459
Mailing Address - Fax:
Practice Address - Street 1:205 W WORTHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4419
Practice Address - Country:US
Practice Address - Phone:704-910-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2360225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist